Perioperative deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in a deep vein, typically in the legs, during or after surgery. This condition is particularly concerning because it can lead to pulmonary embolism (PE), where the clot travels to the lungs and blocks blood flow (1). Perioperative clinicians must understand the risk factors, prevention, and management of DVT in surgical patients.
One of the major risk factors for perioperative DVT is prolonged immobility. During surgery, patients remain immobile for an extended period, which slows blood flow in the veins and increases the risk of clot formation. The risk increases further after surgery, when patients may be confined to bed for days. This is especially common with orthopedic procedures such as hip and knee replacements, where postoperative mobility is limited (2). The longer a patient remains inactive, the greater the risk of DVT, making early exercise after surgery an important preventive measure.
Certain patient characteristics also increase the likelihood of developing DVT. Older adults are at higher risk due to changes in blood circulation and a natural increase in clotting tendency with age. Obesity also increases the risk of DVT formation because excess body fat increases venous pressure and promotes inflammation, both of which can contribute to clot formation. A history of blood clots is another important risk factor, as patients who have previously had a blood clot are more likely to have another (3).
Other medical conditions are also risk factors for perioperative DVT. Cancer patients have an increased risk of DVT because some tumors release substances that promote blood clotting. Chronic inflammatory diseases, such as rheumatoid arthritis, also contribute to clot formation due to long-term activation of the immune system. In addition, patients with kidney or liver disease may have imbalances in blood clotting factors, which can make clot formation more likely (4).
Surgical factors also contribute to perioperative DVT risk. Prolonged surgery, especially longer than four hours, significantly increases the likelihood of clot formation due to prolonged immobility. The choice of anesthesia is another key factor, with studies suggesting that general anesthesia is associated with a higher risk of DVT than regional techniques such as spinal or epidural anesthesia, which help maintain better circulation in the legs (5). In addition, significant blood loss or the need for transfusions may disrupt normal coagulation mechanisms, further increasing the risk of DVT.
Prevention of perioperative DVT involves a combination of strategies. Blood thinners, such as low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs), are often used to prevent clot formation in high-risk patients. However, these medications must be carefully managed to avoid excessive bleeding. Mechanical devices such as compression stockings and intermittent pneumatic compression pumps can also help improve blood flow and reduce clot risk (2). Encouraging patients to move as soon as they are able after surgery is one of the most effective ways to prevent DVT by helping to maintain healthy circulation.
Physicians also use risk assessment tools, such as the Caprini score, to identify patients at highest risk for perioperative DVT. These tools consider factors such as age, weight, medical history, and type of surgery to determine the best prevention strategy. Recent advances in predictive modeling and artificial intelligence have improved the accuracy of these risk assessments, allowing for more personalized preventive measures (4).
References
- Ervando H, Ridwan LS, Dilogo IH. Factors related to deep vein thrombosis as a complication of post-total hip arthroplasty patients: a systematic review. Eur J Orthop Surg Traumatol. 2025;35(1):82. Published 2025 Feb 28. doi:10.1007/s00590-025-04209-4
- Maman D, Eynhoren G, Ben-Zvi L, Steinfeld Y, Yonai Y, Berkovich Y. Impact of Bariatric Surgery on Postoperative Outcomes, Complications, and Revision Rates in Total Knee Arthroplasty: A Big Data Analysis. J Clin Med. 2025;14(4):1187. Published 2025 Feb 11. doi:10.3390/jcm14041187
- Huang L, Luo J, Wang Y, et al. Risk factor of postoperative pulmonary complications after colorectal cancer surgery: an analysis of nationwide inpatient sample. Sci Rep. 2025;15(1):2717. Published 2025 Jan 21. doi:10.1038/s41598-024-84758-6
- Li H, Li Z, Yang N, et al. Perioperative ultrasound screening of lower extremity veins is effective in the prevention of fatal pulmonary embolism in orthopedic patients. Sci Rep. 2025;15(1):229. Published 2025 Jan 2. doi:10.1038/s41598-024-84572-0
- Pannucci CJ, Osborne NH, Wahl TS, Henderson WG, Harrell FE, Thacker JK, et al. Variation in venous thromboembolism risk among patients undergoing general surgery based on procedure type. Annals of Surgery. 2017;265(3):570-578.